Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Publication euphoria
- David S.Y. Chan (24 March 2007)
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Where is the defence of MMC?
- Sean Monaghan (24 March 2007)
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No confidence in Mr Eccles' views
- Alex B Thomson (25 March 2007)
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Suspicions confirmed
- Maaz A Abbasi (25 March 2007)
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competing interests
- carlo palmieri (27 March 2007)
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Conflicts of Interests
- Simon J A Eccles (28 March 2007)
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Conflicts of Interest
- Chris M Laing (29 March 2007)
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misrepresentative
- benjamin dean (29 March 2007)
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Lack of Leadership
- Stephanie L Trevelyan (30 March 2007)
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Re: Lack of Leadership
- Jayaprakash Ayillath Gosalakkal (31 March 2007)
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David S.Y. Chan, Medical student Cardiff University CF14 4XN
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Writing and publishing papers need not be at the expense of enjoying clinical medicine. The euphoria, albeit temporary, of seeing your name in print or after searching PubMed is a huge enough incentive for doctors or even students to write. Competing interests: DC is hoping to get his next fix soon. |
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Sean Monaghan, Final year medical student University of Birmingham B15 2TT
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In Eccles's letter [1], titled 'In defence of MMC and MTAS', he uses the knowledge he gained as Chair of the Junior Doctors Committee to explain the logic behind the MTAS system. These changes seemed to be well- meaning, if flawed in their execution. However, in reading his letter, I failed to see any defence of MMC. In fact, he seems to argue against it - if the new system is supposed to stop distracting juniors from a 'mad scrabble' and give us time to 'enjoy learning clinical medicine', then perhaps he could explain why I will have approximately 18 months from starting my first house job in August to make a final decision about my chosen speciality? 'Modernising Medical Careers' seems a long way from the apparent original vision of 'Improving Medical Training'. References: [1] Eccles SJA. In defence of MMC and MTAS. BMJ 2007;334:601 Competing interests: SM doesn't have the luxury of having already attained his CCST - or, indeed, his MBChB! |
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Alex B Thomson, Doctor Maudsley Hospital SE5 8AZ
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Simon Eccles is wheeled out again to defend government policy, and again declares that he used to be chairman of the BMA Junior Doctors' Committee. Yet he seems to have changed his tune. In 2004 he led the JDC in a vote of no confidence against the Modernising Medical Careers process [1], which has not changed substantially since that time. What seems to have increased is Mr Eccles' involvement with the government - as advisor for a number of controversial government projects for the NHS including Hospital at Night [2,3] and the National Programme for IT, there were sufficient concerns over his conflicts of interest as JDC chair that he faced a vote of no confidence. It is a shame that he survived, but he should now stop using the badge of former JDC chair as can no longer be considered to represent the interests of junior doctors. 1. studentBMJ 2004;12:221-264 http://www.studentbmj.com/issues/04/06/news/227b.php 2. BMJ Career Focus 2004;328:19; http://careerfocus.bmj.com/cgi/content/full/328/7431/s19 3. NHS Blog Doctor 2005; Dec 15 http://nhsblogdoc.blogspot.com/2005/12/sue-and-dave-and-hospital-at- night.html Competing interests: Dr Thomson is a UK-based junior doctor who, like many, would rather leave the UK than accept the current threats to professional standards in postgraduate medical training. |
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Maaz A Abbasi, SHO Cardiothoracic Surgery The Royal Brompton Hospital
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I was astonished to read the comments of Dr. Simon Eccles in BMJ 334:601 regarding the MTAS selection methodology. Firstly, it is essential that Dr. Eccles expands upon the "rampant discrimination" in the old system in which he himself successfully trained. Secondly, the new system does not prevent the "mad scramble" for postgraduate diplomas and publications, but in fact exacerbates the problem further as Foundation Year trainees increasingly find themselves heavily engrossed in churning out compulsory audits and scrapping for any opportunities to publish as a means to ensure entry into ST training- especially in light of the events of the last month. Junior doctors have repetitively voiced their grave concerns regarding the implementation of MMC for some time and the inertia of the BMA to act during this time period has become apparent given the revelation of the attitudes of the former Chairman of the Junior Doctors Committee. This further ignites the popular belief among doctors that the BMA have become alienated from those whom they claim to represent. I envisage that the task to regain the trust of its members will be a long and arduous process, should they wish to do so. 1. Coombes R. How specialist training reform sparked crisis of confidence. BMJ 2007; 334:508- 9 (10th March) 2. Brown MJ, et al. Raging against MTAS. BMJ 2007 Mar 7. www.bmj.com/cgi/letters/333/7579/0-f#161670 3. Eccles SJA. In defence of MMC and MTAS. BMJ 2007 Mar 24. Competing interests: None declared |
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carlo palmieri, Consultant SW17
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I wish to raise an issue with Dr Eccles declaration on competing interests. The connectingforhealth.nhs.uk website clearly lists a number of other activties with which Dr Eccles is involved in with the Department of Health. These are: (1)National clinical lead for hospital doctors-connecting for health (2)Clinical advisor to the NHS National Workforce Project, tackling the impact of the Eurpean Working Time Directive in 2009 (3)Clinical advisor to the Health Insight Unit of the Department of Health (4)Secondment to the Modernisation Agency as the medical advisor to the Hospital at Night project which is now being implemented nationally Richard Smith in an editorial called 'Beyond conflict of interest Transparency is the key' Laid out the importance and rules surrounding conflicts of intrest or as he called then competing interests. http://www.bmj.com/cgi/content/full/317/7154/291 Dr Eccles may want to read this editorial. Smith clearly laid out the BMJ policy and stated 'If we learn after publication that authors had competing interests that they did not disclose then we will tell readers.' Dr Eccles involvement with the Department of health is a clear competing interest and should have been declared when his letter was published. The BMJ should publish these other competing interests and I believe an apology is due from Dr Eccles to the readership of the BMJ for not declaring these in his original letter. Transparency and openess are vital and none so more when there is a conflict of interests. I look forward to the BMJ up holding their former editors statement'If we learn after publication that authors had competing interests that they did not disclose then we will tell readers.' Competing interests: None declared |
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Simon J A Eccles, Consultant in Emergency Medicine Homerton Hospital
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I thank Dr Palmieri for allowing me to clarify my various roles with respect to possible conflicts of interest. I work as an Emergency Department consultant in London, in this role I also act as a clinical supervisor and educational supervisor to doctors in training. I am the National Clinical Lead for hospital doctors for NHS Connecting for Health. I am the clinical advisor to NHS National Workforce Projects which aim to help trusts deliver compliance with the EWTD for 2009. I have recently given up being clinical advisor to the Health Insight Unit at the Department of Health where I assisted (for one day a month) in work on consumer choice. I was the clinical advisor to the NHS Modernisation Agency on the Hospital at Night project in 2003-4. I continue to give occasional advice on reducing doctors’ hours. To date I have done so to US Healthcare providers and the governments of Ireland, Poland, Hong Kong and Australia. I was chairman of the BMA Junior Doctors Committee in 2003-5. To quote the current guidance on BMJ.com "A competing interest exists when professional judgment concerning a primary interest (such as the validity of research or the choice of an external supplier) may be influenced by a secondary interest (such as financial gain)." None of these activities, bar advising doctors in my own department, are connected with the selection processes for doctors in training. I have not been involved with MMC personally since 2005 when I stopped being JDC Chair. Just to be clear. I have not got, nor have I ever had, any conflicting financial interest with MMC or MTAS. I have not worked with or advised the MMC team, the Department of Health or government on doctors’ selection in any capacity other than as JDC chair - and that was over 2 years ago. The act of advising NHS-wide bodies or the Department of Health about unrelated issues does not, of itself, provide a conflict of interest. Competing interests: None declared |
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Chris M Laing, Specialist Registrar in Nephrology and Intensive Care Medicine Guy's and St Thomas's NHS Trust
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Simon Eccles is as entitled to his views on MMC and MTAS as we all are. The protestations about MMC/MTAS represent a well intentioned effort to hold the Department of Health to account for what most (including myself) consider to be a truly catastrophic failure of policy and administration, and of course to seek redress. I agree with the previous correspondants that Dr Eccles, as someone who is so closely associated with the Department of Health, cannot claim to have no conflict of interest as regards his opinions on MMC/MTAS. It would seem obvious that in the current, admittedly regrettable culture, were he to openly criticise DoH policy on MMC/MTAS his various positions with the DoH would be jeapordised. Most would agree that erring on the side of disclosure, and letting the readers decide, is best practice. It would certainly be considered necessary were one, for example, giving an opinion on a drug manufactured by a drug company while being sponsored by the same company on a different product. History will judge whether Dr Eccles support of MMC/MTAS (and indeed the nationalised IT project) is judicious, though I wouldn't bet on it. In the meantime I would welcome other defenders of MMC/MTAS putting their arguments out on websites such as these, but as transparently as possible. Competing interests: None declared |
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benjamin dean, sho oxford
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Whether Dr Eccles agrees or not that his alliance with the government NHS reform agenda is a conflict of interest is of little relevance to the main point of my argument. The main point I intend to make is that Dr Eccles' defence of MTAS is massively misrepresentative of the views of the medical profession. The only Royal College to ballot its members on MTAS found an overwhelming majority of members agreed it should be scrapped, this was the Royal College of Surgeons; I'm sure if the other Colleges were as democratic as the RCS then they may get a similiar opinion fed back to them. A recent survey of over one thousand junior doctors by remedy uk found that over 80% of juniors wanted MTAS scrapped and over 70% wanted a return to the old deanery applications. I have also recently conducted a survey of trainees in my area that has found a large majority in favour of scrapping MTAS. I have yet to see a piece of evidence or survey that shows there is any decent volume of opinion siding with Dr Eccles. The majority of sensible opinion must outweigh the small minority of apologists like Dr Eccles, otherwise untold damage will be done to medical training in this country. Competing interests: member of remedy uk, a non political organisation who have no confidence in the current prescribed NHS reform |
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Stephanie L Trevelyan, SHO Intensive Care Lancashire Teaching Hospitals, Preston, PR2 9HT
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The response of the BMA and its publications, the BMJ and BMJCareers to the spiralling crisis of MTAS and MMC has amazed me and the majority of my colleagues. In the BMJ, the issue has been treated as a specialist side debate, ever so kindly being given airtime on the letters page with a half in favour, half against approach. BMJCareers has placed a couple of jaunty 'isn't it wacky' style pieces in the Newshound section. The BMA, our so-called union, has deigned to give the issue a whole icon on its website, which directs the user to a page suggesting that those concerned by the matter 'contact their MP'. The fact that it has been left to a group of junior doctors to set up their own self funded pressure group and website (www.remedyuk.org) to properly articulate the calamity of what is currently happening, should leave those in charge at the BMA and BMJ hanging their heads in shame. It is RemedyUK that has provided the forum for those juniors in despair. It is RemedyUK that organised the march in London attended by 12,000 Doctors. It is RemedyUK that has sought legal advice regarding the MTAS system and the latest Review Board decision and found (unsurprisingly) that it is discriminatory and open to legal challenge. It is RemedyUK that have sent out proforma letters to all members to allow them to make this challenge. It is RemedyUK that have organised a lobby of Parliament in April. It is RemedyUK that have been in contact with media organisations in the hope of communicating an issue that is currently convulsing the Medical profession. The problems with MTAS are not a side issue for the profession. It effects everyone, from Consultants and GP principles through to Medical Students. It is the future of our profession and the standards of medical training that we are fighting for. Every survey that has been undertaken has shown that over 80% of doctors are in favour of scrapping MTAS and re-running shortlisting on CV based system. All juniors currently involved in this sorry debacle are facing the real prospect of not just the end of their careers, but the much more basic concern of unemployment. The demoralisation of the junior workforce, the inevitable loss of bright young doctors from medicine, and the lack of concern and leadership shown by those in charge is something that will have implications for British medicine for years to come. It is about time that our so-called union, and the publications meant to represent the views of the profession, recognised this and responded accordingly. Competing interests: None declared |
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Jayaprakash Ayillath Gosalakkal, Consultant Paediatric neurologist LE8 6JJ
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The ethnic minority doctors and International medical graduates are used to having to fight their own corner whether it is for a legitimate share of plum positions in the NHS, good job plans, selections or disciplinary action. The organizations, which take our membership fees, have been missing in action on every issue, which has concerned us whether it is abrupt change in the visa system, discrimination in appointments to position in the Trust or as clinical managers. We however support the junior doctors in their efforts to making the system better. We are most aware of the perils of divisions based on colour, class, and nationality. I think really there is only Good medicine and bad medicine and our aim should be to encourage meritocracy. Many of us have held to this principle and have conducted all selection processes without fear of favour. We are however sad and discouraged when neither the BMA nor our professional colleagues whether in the BMA or outside join us in our fights for a meritocracy. However we will not let that interfere in our primary responsibility to provide a world class service based in the NHS with competent training and good selection methods Competing interests: Believer in a true meritrocracy |
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